Frostbite in Edmonton
- Boyle Street Staff
- 5 days ago
- 4 min read
The frostbite we see at Boyle Street is far more severe than red ears numbed after shoveling snow. We see freezing injuries: bone exposed to open air, skin sloughing off like wet paper, fingers blood-blistered to twice their normal size, feet turned black with necrosis.
Frostbite of this degree is caused by being unsheltered in the cold. Windchill is a risk factor, as it lowers skin temperature, and wetness is another risk factor because it nullifies protective gear, such as gloves.
But the greatest risk factor is lack of shelter. Last year in Edmonton there were 113 amputations due to frostbite, and 58% of the patients were houseless. This number undercounts the issue – many people living rough never seek care for their freezing injuries.
How does this happen?
For Robert*, one of our community members, it happened after passing out in the cold while holding his phone. It was about −13 °C and his phone froze to his skin. When he woke up, he was in the hospital, with no memory of how he got there. He lost half his right pinky but was saved from worse by the attention and care of a stranger who took a moment to check in on him. That lost pinky is not counted among the 113 amputations, because it was never amputated. It fell off.
We asked Robert what would have made a difference for him.
“Gloves. Maybe not being outside,” he said. “If I had a place, I would have been there instead.”
CONTENT WARNING: If you click to expand, you will see graphic images of Robert's freezing injury, including necrosis.
Stories like Robert’s are all-too common among those we serve. Some people can’t make it to a warming space because of mobility issues, or there isn’t space available, or they are trying to get to a critical appointment they’ve been waiting for, or they fear leaving their encampment because their belongings might get taken while they’re away. Perhaps they’re fleeing an unsafe environment. They may be trying to quit a substance cold turkey, which is not advised but not uncommon, leading to increased irritability and aggressiveness that gets them barred from safe spaces. Or perhaps someone can’t fit their bandaged hands into their gloves.
Each case has a unique background, but the outcome is the same: being outside in the cold.
The effects of freezing injuries don’t end once a patient is discharged. Many of those we serve leave urgent care without a full understanding of the severity of their freezing injury, or unclear follow-up instructions. It is a difficult and time-consuming process for our staff to find out what the care instructions are and ensure our community are informed of the next steps, and often by the time they do find out an appointment has passed.
These follow-up appointments are critical but often missed. Even if the instructions are clear and the patient remembers them at the moment, it can be difficult to keep track of everything without any sort of assistance – assistance like reminders of dates, transportation, advocacy during appointments, or finding warm clothing that fits over bandaged areas. And those we serve often face discrimination when seeking medical care, leading them not to seek it again.
But even without these factors, there are other systemic barriers to their care, and these barriers reinforce each other.
For example, it is difficult to access rehabilitation for a lower-extremity amputation at post-acute facilities without a home to be discharged to. This means that people will be discharged from hospital with only a wheelchair, often earlier than many others in our communities who are housed.
But part of the housing intake process is the Service Prioritization Decision Assistance Tool (SPDAT). Frostbite and amputations increase your SPDAT score, which makes it harder to qualify for market housing assistance. This is because higher scores qualify for supportive housing - but there are far fewer supportive housing units than market housing units in Edmonton.
The cycle reinforces: it’s harder to find a place to live, making it harder to rehab your injury, which makes it harder to find a place to live. Additionally, many organizations that provide funding for mobility aids such as walkers won’t fund equipment unless the recipient has a permanent address. Or even if they do provide equipment, repairing that equipment is expensive, and freezing injuries make it harder to find work and make money.
These barriers reinforce each other, and the outcome is the same: being outside in the cold.
You can make a difference right now by checking in on someone in distress, like Robert, and calling for help if necessary.
You can also donate to Boyle Street’s Emergency Response Fund (ERF). Our ERF allows us to purchase the supplies necessary to respond to extreme weather and other emergencies. It is preventative, because we can purchase the supplies ahead of time and distribute them before the worst weather hits. If Robert had mittens, he would still have his whole pinky finger.
But most importantly, you can advocate for long-term, systemic change. Robert recently became unhoused again and suffered another freezing injury – this time the tip of his right index finger froze. If Robert had housing, he would still have all his fingers.
CONTENT WARNING: If you click to expand, you will see a graphic image of Robert's freezing injury.
As a community, we can prevent freezing injuries with mittens, with shelter, with follow-up care, and most importantly, with housing. We can expand Edmonton’s medical and housing capacity. We can treat each other with kindness, and support each other regardless of circumstances, to make it through to another day and another season.
Until we do, winter will keep taking pieces of people.
*The name of our community member has been changed to respect their privacy.